Transcript Cardiac Service Line - National Health Care for the

Recuperation Care Program
2008 HCH Conference
Respite Care Provider’s Network
June 11, 2008
Phoenix, AZ
Successful Collaborations
Between Respite Programs
and
Hospital Partners
Toni Propotnik, MN, RN, CMAC Division Director, Care Management & Psychiatric Nursing
Ted Amann, MPH, RN - Director of Healthcare and Improvement
Corey Padron, EMT-B - Manager, RCP
Hospitals & Respite Care
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Why collaborate?
How to begin collaborating?
Why would hospitals support respite?
What do hospitals want?
What to do and what not to do in
proposing a program to a hospital partner
• How to sustain the collaboration?
OHSU Healthcare at a Glance
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Licensed Beds: 560
Occupancy Rate: 84 percent
Average Length of Stay: 5.3 days
Case Mix Index : 1.8
Hospital Stays: 29,000
(total hospital discharges)
Emergency Department Visits: 36,000
Specialty Children’s Hospital
Level I Trauma Center
Level III NICU
Transplant Programs – Solid organs to BMT
Commitment to care for the Underserved
“Adapting to the changing fiscal and healthcare landscape
while maintaining essential social benefits requires foresight,
innovation, and new sources of revenue. Together, OHSU, the
state, the broader health care community, insurers, and
patients must craft solutions that are financially viable and
compassionate so that medically underserved populations,
including rural communities, receive adequate healthcare now
and far into the future.”
OHSU as a Resource for Care
• OHSU cares for a disproportionate share of people with
Medicaid or Oregon Health Plan coverage that pays
providers less than the cost of health care.
• OHSU cares for the state’s most vulnerable citizens; it
serves individuals with cultural and language barriers,
people who can’t afford care, and the most seriously ill.
One-third of OSHU’S hospitalized patients are unable to
afford their care
• In 2007, OHSU sustained uncompensated costs totaling
about $53 million to provide health care to people who
could not pay.
About Central City Concern (CCC)
• Formed in 1979
• Operates continuum of
affordable housing
integrated with healthcare,
addictions treatment,
recovery support, and
employment services
• Over 15,000 low-income
and homeless individuals
access services annually
• 501(c)3 Non-profit
• $28 million annual budget
• 450 employees
8NW8
Residents in the
community room
The Collaboration of RCP and OHSU
• The RCP began with a meeting between
Central City Concern and OHSU
• Acknowledgement that we have clients in
common who are high utilizers of ER; with
considerably longer inpatient stays due to
living on the streets.
• These factors contribute to higher hospital
expenses and difficulty with coordination of
patient care and follow up.
How to begin?
• Reach out and make contact
– Case Management (usually a RN/CM or CSW)
– ED CM or RN Manager
– Other options: Patient Advocate, Chaplain, Psych
• Find out the hospital’s needs and concerns
– Offer another discharge “option”
• Examine how your program can address
those needs and concerns
– You are selling them a product, so make a product
they will want to buy
What does OHSU Care Management need?
Challenges:
• Maintain Low LOS
• Ensure patient flow/capacity management/through-put
• Ensure cost effective, quality care
Staff:
• RN Case Managers, Social Workers, Clinical Nurse
Specialists
Care Management Functions:
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Utilization Review
Discharge Planning
Social Services
Outcomes (Clinical & Financial)
Resource Management
Targeting Long LOS cases
2004 Top Reasons for “avoidable days”
• Inadequate / no funding for post hospitalization ongoing
care needs
• Very complex placements (ventilator care, bariatric and
wound care)
• Inadequate patient support at home
• Homelessness
How to make a proposal
• Do your homework first
• Find the win-win
– You don’t need to have identical goals; agree on
systems & processes that achieve multiple goals
• Your primary care engagement is their decreased ED usage
• Your housing placement is their decreased inpatient
recidivism
• Speak the same language
– To a hospital “rooms”/“units”/“apartments” = “beds”
– A hospitals primary focus is medical
Making your pitch:
Why would hospitals support respite?
• Shorter length of stay for patients
– You can sell an early discharge service
– They can fill that bed with an insured patient
• Less inpatient recidivism
– Stabilizing the client both medically and socially
decreases the likelihood of repeat admits
• Less unnecessary ED utilization
– Primary care engagement
– Client education on how to use the healthcare system
What not to do
• Don’t design a program in a vacuum and
expect a hospital to pay for it
• Don’t sell beds, sell referrals or intakes
• Don’t create a program that sounds good but
doesn’t actually meet hospital needs
– Ease of referral
– Timeliness of response
– Feedback
• Don’t assume the moral high ground
– Hospitals do a lot of charity care & community
benefit
• Don’t expect to get without giving
How to sustain the relationship
• Communicate, communicate, communicate
• Check in with the people “on the ground”
and “at the top”
– How well does it work for the people who
actually make the referrals?
• Respond to their concerns – don’t be rigid
• Share your concerns – don’t fester
• Provide timely data
Case study – Mr. F
• attacked by 2 people & pit-bull
• required facial reconstructive surgery
• homeless for over 10 years; no job; no
insurance; no family; no primary care
• D/C planner calls RCP; same day eval; next day
intake to RCP
• Hospital provides 30 d Rx & specialist appts
• RCP provides housing, meals, primary care,
transportation, case management, access to
CCC continuum of care
• Today: housed, healthy, clean & sober
Outcomes - RCP
In the last year, RCP
patients resolved 83%
of their acute medical
issues and 59% of RCP
patients left to Stable
Housing (23% of which
includes permanent)
5% 6% 1%
Resolved
5%
Left AMA
Reoccurance
Unresolved
83%
Deceased
Permanent
17%
23%
23%
Stable/Transitional
(with support)
Street/Shelter
37%
Other (Hospital, Jail,
Other unfavorable)
OHSU pilot projects
Catastrophic Financial Case Management
Pilot program to develop new projects to
increase discharge options
• Community partnership for skilled nursing placement of
complex care patients
• Recuperation Care Program
• Salvation Army Infirmary
Outcomes - OHSU
RCP is the most successful program to date
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“Homelessness” is now off the list as a barrier
2005: 18 cases / 6mo.
2008: 30 cases / 6 mo.
3 year OHSU costs $570,0000
• 3 year OHSU savings (cost avoidance and back fill ) $3.4 M +
• 13 day reduction in Length of Stay for a sampling of 10 OHSU
patients referred to RCP
• Outcome: patient centered care across the continuum